title: Impact of official technical training for urologists on the efficacy of shock wave lithotripsy.
abstract: To evaluate the efficacy of company-initiated training of urologists on shock wave lithotripsy (SWL) treatment results, we retrospectively assessed 602 patients who underwent SWL in Nagoya City University Hospital between January 2004 and June 2011 using Lithotripter S (Dornier MedTech, Japan). Training-provided by a training specialist of the company in June 2010-focused on the targeting of renal and proximal ureter stones with a combination of radiography and ultrasonography (US). The stretcher wedges were positioned in the semi-prone position or the semi-supine position for middle and distal ureter stones, respectively. Success rates between 519 pre-training treatments and 83 post-training treatments were compared. Patient age and stone location, burden, number, and composition did not significantly differ between pre- and post-training. Training improved the overall success rate from 66.3 to 87.2 % (P < 0.0001). The mean number of SWL treatments decreased from 1.8 ± 1.8 to 1.4 ± 1.3 (P = 0.01). The first SWL treatment success rate increased from 67.1 to 83.7 % (P = 0.002), and the need for multiple treatments decreased. The frequency of detection of renal and proximal ureter stones by both radiography and US increased from 10.5 % before training to 58.2 % after training (P < 0.0001). Significant factors for successful SWL were determined to be training and prone position for distal ureter stones by multivariate analysis and ultrasonic detection for renal and proximal ureter stones by univariate analysis. Skills in targeting stones using ultrasonography and selecting the proper therapeutic position are essential for improving the success rate of stone removal.
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okada
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yasui
authors.forename: Kazumi
authors.initials: K
authors.lastname: Taguchi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Niimi
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hirose
authors.forename: Shuzo
authors.initials: S
authors.lastname: Hamamoto
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Ando
authors.forename: Yasue
authors.initials: Y
authors.lastname: Kubota
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Umemoto
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tozawa
authors.forename: Shoichi
authors.initials: S
authors.lastname: Sasaki
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kohri
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014572:Urology / Q000193:education*